Updated: Feb 12
Let me preface this by noting that I had to be ready to go by 6:30 AM for this experience. Ever since transitioning from the Sim Lab to Clinic, I have not had as early of a start if we're not counting traveling.
With that said, this was 100% worth it!
6:30 AM: Meet up with the group and drive over to Milwaukee's Children's Hospital
We then had to sign in and find the surgical floor. The hospital is massive and consistently being renovated, so we had fun getting around.
The hospital requires us to change into scrubs the hospital's surgical team uses, which happens to be a Caribbean Blue! This is one of my favorite colors available in the Uniform Advantage Butter-Soft Stretch styles I love, but these were not Butter-Soft, lol.
7 AM: Meet the O.R. nurse & Anesthesiology resident + Debriefing from Pediatric Dentist
7:30 AM: Meet parents and child to discuss how the procedure will go
Not only did we discuss risks, but benefits & Tx options, we also wanted to figure out if one particular side had been bothering the patient more than any of the others. Turns out the patient had recently begun complaining of pain, and we soon found out why.
8:15 AM: Enter Patient
Having had to go under G.A. last year myself, it was interesting seeing everything from the other side. Our patient was pre-medicated prior to coming into the O.R. and was still very combative. We watched the patient go through various stages before being fully anesthetized.
For my surgeries I was intubated through my mouth, as is usually the case, however, we watched our patient be intubated via his nose because we need the space to properly work in his mouth.
All of the radiographs we needed, we were able to take using a Nomad, and we had a mini dental desk that housed our handpieces. The burs and materials we brought ourselves. The 2-hour O.R. block meant that we had to work fast as a team and we had to be ready to adapt to whatever we found once the patient was able to be evaluated.
This was a great exercise in caries excavation because as the D4, I had to excavate the quadrant with the most decay and somehow not pulp the tooth. I was sweating, but we survived and then finished up with conventional crown preps. The pediatric dentists handled some of the more involved procedures such as placing 2 distal shoes for space maintenance after extractions and esthetic fillings.
9:45 AM: Finish up & Start Waking the Patient
Our team was able to do 6 crowns, 2 fillings, and 2 extractions in 1.5 hours!!
This child was so combative in the general clinic, and would not have been able to receive the care needed had it not been for sedation. Luckily, his parents were very proactive in getting him on the sedation list (avg. 6-month waitlist), and were extremely grateful when we were done.
Apparently, O.R. cases for dentistry are not very lucrative for hospitals. As a result, teaching hospitals are the ones more likely to allow dentists to schedule cases, rather than a non-teaching hospital, due to the nature of patients and the insurances these patients usually have.
By the same token, there are so many patients who do need dental work under sedation for various reasons, whether they are children with insurmountable behavioral issues and/or patients of any age with special needs, that we do need to keep hospital privileges a possibility.
For those of you considering specializing or doing a GPR, please consider seeing patients that need dental care in this specific setting. I can't tell you how rewarding this experience was.